each peer reply should be at least a paragraph in length and contain substantive addition to the discussion.
peer 1: There are several different reasons to insert a chest tube. There are different conditions and/or trauma that could make a chest tube necessary for survival. Chest tubes are used to treat conditions that can cause a lung to collapse. The chest tube is inserted to restore the negative pressure in the lung cavity (Tkacs & Johnson 2021). Disruptions to that negative pressure can be from: air leaks from the lung into the chest (pneumothorax), bleeding into the chest (hemothorax), after surgery or trauma in the chest (pneumothorax or hemothorax), and lung abscesses or pus in the chest (empyema). Therefore, the chest tube will be removing air, blood, and/or pus. Looking at Mr. T’s study, because he was in a motor vehicle accident, chest tube is already a thought.Sputum is a saliva/mucous mixture that is coughed up from the respiratory tract, and it is a very useful tool for diagnosing what is going on inside the body. Sputum can be a variety of different colors, all meaning something different. For instance, mucous that contains bubbles and is foamy is called frothy sputum. When a patient coughs up frothy sputum, that can be indicative of chronic obstructive pulmonary disease (COPD), gastroesophogeal reflux disease (GERD) or pneumonia (Norris 2020). In this case study, Mr. T has blood-tinged sputum that’s observed when the nurse suctions his artificial airway. Combined with the fact that we know that Mr. T has a chronic lung problem, the blood-tinged sputum is most likely indicative of COPD. There are two nursing diagnoses that are appropriate for Mr. T, among others. But two of them are ineffective airway clearance and impaired gas exchange. There are some potential complications that the nurse(s) taking care of Mr. T need to look out for. Mr. T has a chronic lung condition that could very likely be COPD. With him having this chronic condition, his healing from the injuries from this accident will be slower than normal. Also, looking at the fact that there was a chest tube inserted, that leaves areas for infection to creep in…especially if the dressings aren’t changed, or if things aren’t kept sanitary. Looking at Mr. T’s earlier stats, he does have a pneumothorax, and that is why the chest tube was inserted in the first place. But now looking at his stats after the intubation, Mr. T has an infection. I am thinking that he has pneumonia due to the intubation, evidenced by the low grade fever and the tachycardia. Having this infection to deal with will also slow Mr. T’s healing process. With Mr. T being bedridden at this point in time, the nurse also needs to watch out for pressure ulcers and edema.
peer 2: The absence of breath sounds on Mr. T’s right side suggests that during his car accident, he likely suffered right chest injuries leading to a collapsed lung. His right lung is likely being compressed by blood (hemothorax) or air (pneumothorax) that is confined in the pleural space. In order to treat Mr. T’s lung pressure, according to Norris and Tuan (2020), a chest tube must be inserted. Radiography via CT or X-ray is needed to verify this diagnosis. To enable proper lung reinflation and expansion, the chest tube should be placed as quickly as possible.
A few days after being intubated, Mr. T is experiencing blood-tinged sputum, a fever, and tachycardia. Pneumonia associated with the ventilator is likely the cause (VAP). According to Karakuzu, Z. Iscimen, R. Akalin, H. et al. (2018), ventilator associated pneumonia is the most common hospital acquired infection and can be defined as pneumonia that develops 48 hours or more after the patient is placed on the ventilator. Ventilators also cause an increase in mucus production as a result, the patient may experience pulmonary edema, which will result in bloody, pinky-frothy sputum when suctioned .Due to his history of chronic pulmonary problems, Mr. T is at an increased risk for VAP. It will be necessary to assess fresh chest x-rays and sputum cultures to confirm this diagnosis. To treat this illness, Mr. T will likely require medications such as antibiotics to treat VAP.
Two nursing diagnosis for Mr. T. would be ineffective airway clearance and risk for impaired gas exchange. Some other potential complications that we would monitor during intubation of this patient would be pressure ulcers, risk of deep vein thrombosis, development of gastric ulcers, secondary pneumothorax, pulmonary edema, etc.
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